Industry Groups Aim to Speed Prior Authorization Process
NATIONAL ELECTRONIC STANdards are expected to play a key role in an industrywide effort to streamline the process of communicating prior authorizations for treatment.
Groups representing hospitals, physicians, medical groups, health insurers and pharmacists have announced a joint effort to facilitate the often lengthy insurance approval process called prior authorization— also known as pre-approvals—that slow delivery of treatment to patients.
The collaboration includes the American Hospital Association, America’s Health Insurance Plans, American Medical Association, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association.
Facilitating the prior authorization process also is expected to provide benefits to the healthcare industry, participants in the initiative say—it could reduce administrative burdens for healthcare professionals, hospitals and health insurers.
Typically, if a treatment or prescription requires prior authorization, it must be approved by a health insurer before it’s administered. These approvals can be burdensome for all parties because the processes vary and often are repetitive. Streamlining can reduce the number of steps and time delays.
The groups have signed a consensus statement, pledging to work together on a variety of initiatives. In particular, they are committing to accelerating industry adoption of national electronic standards for prior authorization and improving transparency of formulary information and coverage restrictions at the point of care.
The organizations say they will seek to improve communication between health insurers, healthcare professionals and patients to minimize delays in care and ensure clarity on prior authorization requirements, rationale and changes.